Dr Drakaki on a Case Study in ALK+ Refractory Metastatic RCC

Alexandra Drakaki, MD, PhD, associate professor, hematology/oncology, urology, Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, discusses a case study of a patient with refractory metastatic renal cell carcinoma (RCC) harboring an ALK rearrangement.

The use of next-generation sequencing (NGS) to understand deregulated pathways in kidney cancer is critical, Drakaki begins. In this case study, published in JCO Precision Oncology, investigators focused on a patient with metastatic RCC who sought a second opinion after their disease did not respond to immune checkpoint inhibitors, targeted therapies, and combination treatments, she explains. Recognizing that recycling the same drug classes would likely be ineffective, investigators opted to biopsy the tumor to gain new insights, Drakaki states.

Unexpectedly, Drakaki explains that investigators discovered an ALK rearrangement in the tumor, which had been present since the initial diagnosis but was either missed or not specifically looked for at that time. Based on this finding, oncologists chose alectinib (Alecensa), an ALK inhibitor, as the treatment. Alectinib was selected due to its efficacy in lung cancer and its known ability to penetrate the blood-brain barrier and central nervous system, she continues. When the patient began treatment, he had significant liver metastases, she notes. Within just a few months, he demonstrated a remarkable response, with imaging showing substantial improvement in both lung and liver metastases, Drakaki expands. At the time of the study’s publication, this patient had been receiving alectinib for approximately 4 years, with continued clinical and radiographic responses, according to Drakaki.

This case highlights the importance of personalized medicine in oncology, she emphasizes. By identifying and targeting specific mutations, such as the ALK rearrangement in this patient, investigators can achieve better outcomes and potentially extend survival, she says. The positive outcomes of this case underscore the need to thoroughly search for targetable mutations as a pathway to improve the longevity and quality of life for patients with metastatic cancer, Drakaki concludes.